Objective To summarize the experiences of diagnosis and treatment of dermatofibrosarcoma protuberans (DFSP). Methods The clinical data of 16 patients with DFSP were analyzed retrospectively. All the patients with DFSP underwent extensive tumor resection (3～5cm margin from the tumors).Free full-thickness skin flap transplantations was performed on 6 cases , three cases received skin flap shifting operations, and 1 patient with abdominal wall deficiency was repaired by artificial mesh . Results All the 16 patients presented as painless cutaneous nodules which enlarged slowly, but the majority of the tumors grew quickly in recent shorter time. Ten cases were primary tumors, and six were recurrence. The time of recurrence after surgery ranged from 3 months to 10.5 years with 1～3 times recurrence. There was no operative complications. Eleven patients were followed-up for 1～11 years and all survived,only one patient developed tumor local recurrence seven years after surgery. Conclusions A slowly enlarged painless cutaneous or subcutaneous nodules quickly growing in recent time is the clinical characteristic feature of DFSP. Extensive tumor resection is the treatment of primary DFSP.

Objective To study the expression and significance of survivin,an apoptotic suppressor gene,in craniopharyngioma. Methods Fifty specimens were collected from patients with craniopharyngioma admitted in West China Hospital of Sichuan University from 2000 to 2005. By using immunohistocbemistry (S-P) method, the expression of survivin in craniopharyngioma was detected. The results were analyzed quantitatively by using digital image analysis. Results Survivin positive expression was observed in craniopharyngioma but not in normal brain tis-sue. There was more expression of survivin in adamantinomatous craniopharyngiomas than in squamous papillary types( P = 0.036 ) , in male than in female (P = 0.002 ), in children ≤ 16 years than in adults > 16 years, and in re-current group than in non-recurrent group( P = 0.011 ). There was no significant difference among different properties of craniopharyngioma ( P = 0. 057 ), and different courses of disease ( P = 0. 083 ). Conclusions Survivin may be considered as a significant index for assessment of tumor recurrence.

Objective To determine the prevalence of microembolic signals (MES) by using transcranial Doppler (TCD) and to assess their association with neuropsychiatric systemic lupus erythematosus (NPSLE) and clinical presentations in patients with systemic lupus erythematosus (SLE).Methods Forty-four patients with SLE underwent TCD for 30 min were included for MES detection and their clinical information were recorded.In addition to the frequency of patients with MES,patients with MES were followed-up for sixmonth.Mann-Whitney U test and Fisher exact test were applied to investigate the clinical characteristics.Results There were 4 patients with history of NPSLE and the occurrence times were from 8 to 120 month before our study.There were 4 patients had the abnormal neuropsychiatric symptom during our study period.MES were detected in 5/44 patients (11％) with mean 17.6 per 30 min.MES were more prone to be detected in patients with higher systemic lupus erythematosus disease activity index (SLEDAI) score [16(12.5,19) vs 8(5,10),U=14.5,P=0.001],shorter course of disease [1(0.1,48.5) vs 26(13,55),U=38,P=0.028] and neuropsychiatric symptoms [3 vs 1,P=0.003].Conclusion MES may be detected in SLE patients.MES is associated with higher disease activity,shorter course of disease and NPSLE.TCD microemboli detection may be a noninvasive method to evaluate NPSLE patients.

Objective To detect the influence of the perfusion quantity and distribution of bone cement by percutaneous ky-phoplasty(PKP) on the early treatment result of thoracolumbar osteoporotic compression fractures(OVCF) .Methods From May 2011 to May 2013 ,62 cases of osteoporotic fractures of thoracic or lumber vertebra were treated by PKP .CT scans were performed postoperatively to analysis the distribution of the bone cement in the vertebra .According to the bone cement distribution on the transverse plane CT film ,the results were classified into four degrees :excellence ,good ,fair and poor .The cases were followed-up regularly .Preoperative and postoperative visual analogue scale(VAS) ,oswestry dysfunction index(ODI) ,height of the operated ver-tebra ,cobb angle ,the incidences of complications during and after the surgery were compared between groups of different degrees of bone cement distribution and different amount of bone cement injection .Results Among the 62 cases ,the follow-up time ranged from 3 to 36 months[average(10 .5 ± 5 .3)months] .In all of the cases ,there was statistically significant difference between the pre-operative and postoperative VAS scoring(P< 0 .05) .3 months after suergery ,there were no statistically significant influence on the results of VAS scoring ,the ODI scoring ,the height lost of the operated vertebra and the improvement of the Cobb angle(P> 0 .05) . In cases of bone cement injection more than 5 mL ,adjacent vertebra fractures happened in 3 cases 6 months postoperatively and 6 cases 12 months postoperatively .In cases of bone cement injection less than 4 mL ,there were only 2 cases of adjacent vertebra frac-tures happened 12 months posoperatively .The degree of vertebra height lost between the bone cement excellent group and poor group was statistically significant in 6 months and 12 months postoperatively .In cases when the distribution of bone cement was ex-cellent ,the improvement of pain and function was significantly different(P< 0 .05) .Conclusion OVCF is treated by PKP .Through conventional operation ,the ultra-early(within 3 months)efficacy is excellent ,in cases of different amount of bone cement injection and different degree of bone cement distribution .However ,with appropriate amount of bone cement ,the more eventfully and sym-metrically the distribution of the bone cement is ,the better of the early clinical results ,probably .

Objective To evaluate the effects of sodium-glucose cotransporter 2 ( SGLT2) inhibitors on the stroke risk for patients with type 2 diabetes mellitus (T2DM). Methods A systemic meta-analysis including 30 random control trails ( RCTs) was performed to compare the risk of stroke between type 2 diabetic patients treated with SGLT2 inhibitors and control drugs. Then their bias risk and quality were assessed and meta-analysis was conducted using Stata12.0 software. Results Thirty RCTs enrolling 74456 participants were selected for meta-analysis. The stroke incidence in the group receiving SGLT2 inhibitor monotherapy or combination therapy did not significantly differ from that in control group, with relative risk (RR) 1.01 (95％CI 0.93-1.10, P=0.978) and 1.00 (95％CI 0.92-1.09, P=0. 874 ) , respectively. Three SGLT2 inhibitors canagliflozin, dapagliflozin, and empagliflozin did not increase the risk of stroke, with similar RR values ( RR=0.91, 0.99, 1.13, respectively) . Subgroup analyses showed that there was no correlation between SGLT2 inhibitors and stroke risk in different gender, age, diabetes duration, body mass index, or HbA1C levels. Conclusions Whether administered as monotherapy or add-on therapy, SGLT2 inhibitors did not increase stroke incidence, and there were no significant within-class differences.

Objective:To evaluate the effect of minocycline on severe ocular rosacea.Methods:Twenty-three patients with severe ocular rosacea were recruited and received 8 weeks treatment. Oral minocycline 100 mg was given daily for the first 2 weeks, and 50 mg daily minocycline daily for the next 6 weeks. The best corrected visual acuity and the eye and body skin conditions before and after treatment were recorded. The visual acuity and the degree of skin and body inflammation were compared before and after treatment to evaluate the efficacy.Results:After 2 weeks of minocycline treatment for severe rosacea eye type, 14 patients had improved eye conditions and dermatitis subsided, with an effective rate of 60.87%; 23 patients had an effective rate of 100% after 8 weeks of treatment. No adverse drug reactions were seen during treatment. The visual acuity before treatment was 0.20±0.09, and the visual acuity was 0.14±0.07 8 weeks after treatment. The patients were followed up for 18 months without recurrence.Conclusions:Minocycline is safe and effective in treating severe ocular rosacea and can control recurrence.

Sphingolipid metabolism is widely involved in the functional regulation of different cells, and also plays an important role in ocular tissues.Sphingosine 1-phosphate (S1P) is the end product of sphingolipid metabolism and has been shown to play an important role in the onset and development of eye diseases.S1P signaling pathway is widely expressed in various ocular cells and is involved in the regulation of cell proliferation, differentiation, migration and apoptosis.S1P activates a variety of signaling pathways by binding to corresponding receptors and thus plays a wide range of physiological and pathological effects in the eye.Recent studies have found that the S1P signaling pathway can not only mediate the normal development of blood vessels and nerves in the eye, maintain the normal structure of the ocular tissues, and participate in the metabolism of lipids in the eye, but also has a close relationship with immune-related inflammatory response, pathological fibrosis, destruction of cell functional barrier and other related pathological changes.This paper mainly reviewed the basic overview of the S1P signaling pathway, its physiological role in the eye, and its role in the pathological changes of anterior and posterior segment diseases, so as to provide new directions and targets for the treatment of eye diseases.

Objective: To study the effect of WT1 expression on the prognosis of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in acute leukemia (AL) and its significance as molecular marker to dynamically monitor minimal residual disease (MRD) . Methods: Retrospectively analyzed those AL patients who underwent allo-HSCT in the First Hospital Affiliated to Zhejiang University School of Medicine during Jan 2016 to Dec 2017, a total number of 314 cases, 163 males and 151 females, median age was 30 (9-64) years old. Comparing the difference of WT1 expression at diagnosed, pre-HSCT and after HSCT. Using the receiver operating characteristic (ROC) curve to determine the WT1 threshold at different time so as to predict relapse. The threshold of WT1 expression before transplantation was 1.010%, within 3 months after HSCT was 0.079% and 6 months after HSCT was 0.375%. According to these thresholds, WT1 positive patients were divided into low expression groups and high expression groups. Analyzed the relationship between overall survival (OS) , disease-free survival (DFS) , cumulative incidence of relapse (CIR) and WT1 expression. Results: The OS and DFS of high expression group pre-HSCT were lower than low expression group [69.2% (9/13) vs 89.1% (57/64) , χ²=4.086, P=0.043; 53.8% (7/13) vs 87.5% (56/64) , χ²=9.766, P=0.002], CIR was higher than low expression group [30.8% (4/13) vs 7.8% (5/64) , P=0.017]. There was no significant difference of OS and DFS between high expression and low expression group of 3 months after HSCT (P=0.558, P=0.269) . The OS and DFS of high expression group of 6 months after transplantation were both lower than low expression group (P=0.049, P=0.035) . Multivariate analysis showed that WT1>0.375% when 6 months after transplantation was the only independent prognostic factor for shorter DFS (P=0.022) . There was no statistically significant difference in CIR between the high-expression group and the low-expression group 3 months after transplantation and 6 months after transplantation (P=0.114, P=0.306) . Conclusion High expression of WT1 before and after HSCT was an adverse prognosis factor. It is of clinical practical value to use WT1 as a transplant recommendation index for patients with acute leukemia and as a marker to monitor MRD dynamically.

OBJECTIVETo evaluate the clinical and radiological efficacy of paraspinal muscle approach with winglike working channel in the treatment of thoracic and lumbar spine fracture.

METHODSFrom October 2010 to August 2012, a total of 51 patients with thoracic and lumbar spine fractures without neurological symptoms were enrolled in the study, including 32 males and 19 females. All patients were divided into two groups: 26 patients were treated through posterior paraspinal muscle approach with winglike working channel, and 25 patients were treated through traditional posterior approach. In all patients, the interval between injury and operation was less than two weeks; the vertebral canal blocked area was less than 1/3 in sagittal diameter; the compression of the fractured vertebra height was less than 2/3. And the patients with pathological fracture and severe osteoporosis were excluded. The perioperative index including operative blood loss, draining loss, operative time, postoperative bed time were recorded. The clinical results were evaluated by visual analogue scale (VAS) for back pain preoperatively, at 3 days, 3 months, the last follow-up postoperatively and modified Macnab criteria at the last follow-up. The radiological results were evaluated by sagittal Cobb angle and the anterior height of the fractured vertebra. The data of two groups were compared statistically with paired and independent t test, χ² test, Mann-Whitney U test and Wilcoxon test.

RESULTSAll patients were followed up with average of 16.6 months. In the two groups, the operative blood loss was respectively (91.5 ± 36.6) ml and (209.2 ± 38.3) ml (t=-11.216, P=0.000), draining loss was (13.7±4.4) ml and (162.3 ± 56.6) ml (t=-13.352, P=0.000), postoperative bed time was (87.3 ± 11.5) hours and (118.4 ± 20.4) hours (t=-6.727, P=0.000), VAS for back pain at 3 days postoperatively was 5.5 ± 1.0 and 6.4 ± 0.8 (t=-3.304, P=0.002), also VAS at the last follow-up was 1.0 (1.0) and 2.0 (1.0) (U=191.0, P=0.008). Data above showed significant differences between the two groups.No significant differences were found in operative time, (109.0 ± 29.7) min vs. (119.2 ± 26.8) min (t=-1.283, P=0.206), and modified Macnab criteria (χ²=0.513, P=0.774) between the two groups. The anterior height of the fractured vertebra preoperatively, at 1 week and the last follow-up postoperatively of the two groups were respectively (57.2 ± 11.8)% and (55.2 ± 10.9)% (t=0.685, P=0.496), (95.2 ± 8.3)% and (95.3 ± 5.8%) (t=-0.068, P=0.946), (92.9 ± 6.7)% and (92.1 ± 5.6)% (t=0.505, P=0.615). The sagittal Cobb angles preoperatively, at 1 week and the last follow-up postoperatively of the two groups were respectively 21.0° (12.5°) and 23.0° (12.0°) (U=316.0, P=0.544), 3.0° (5.5°) and 4.0° (4.5°) (U=342.5, P=0.893), 4.0° (5.5°) and 6.0° (6.0°) (U=328.5, P=0.701). There were no significant differences of these radiological results between the two groups in the same time point.

CONCLUSIONThe paraspinal muscle approach with winglike working channel in the treatment of thoracic and lumbar spine fracture is an efficient surgical option which can acquire satisfactory clinical and radiological results.

Blood Loss, Surgical ; Drainage ; Female ; Humans ; Lumbar Vertebrae ; injuries ; Male ; Operative Time ; Orthopedic Procedures ; methods ; Pain Measurement ; Paraspinal Muscles ; surgery ; Postoperative Period ; Pressure ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; Visual Analog Scale

BACKGROUNDThe prevalence of metabolic syndrome (MetS) increased recently and there was still not a screening index to predict MetS. The aim of this study was to estimate whether brachial-ankle pulse wave velocity (baPWV), a novel marker for systemic arterial stiffness, could predict MetS in Chinese community population.

METHODSA total of 2 191 participants were recruited and underwent medical examination including 1 455 men and 756 women from June 2011 to January 2012. MetS was diagnosed according to the criteria of the International Diabetes Federation (IDF). Multiple Logistic regressions were conducted to explore the risk factors of MetS. Receiver operating characteristic (ROC) curve was performed to estimate the ideal diagnostic cutoff point of baPWV to predict MetS.

RESULTSThe mean age was (45.35±8.27) years old. In multiple Logistic regression analysis, the gender, baPWV and smoking status were risk factors to MetS after adjusting age, gender, baPWV, walk time and sleeping time. The prevalence of MetS was 17.48% in 30-year age population in Shanghai. There were significant differences (χ(2) = 96.46, P < 0.05) between male and female participants on MetS prevalence. According to the ROC analyses, the ideal cutoff point of baPWV was 1 358.50 cm/s (AUC = 60.20%) to predict MetS among male group and 1 350.00 cm/s (AUC = 70.90%) among female group.

CONCLUSIONBaPWV may be considered as a screening marker to predict MetS in community Chinese population and the diagnostic value of 1 350.00 cm/s was more significant for the female group.

Adult ; Ankle Brachial Index ; methods ; Female ; Humans ; Logistic Models ; Male ; Metabolic Syndrome ; diagnosis ; Middle Aged ; ROC Curve